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Sasaki N, Mitomo S, Matsui Y, Ishii Y, Sasaki A. Incarcerated Larrey hernia with small bowel obstruction: A case report. Int J Surg Case Rep 2023; 104:107968. [PMID: 36898264 PMCID: PMC10018542 DOI: 10.1016/j.ijscr.2023.107968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/17/2023] [Accepted: 02/26/2023] [Indexed: 03/12/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Morgagni-Larrey hernias (MLHs) are rare diaphragmatic hernias that can cause incarceration or strangulation of the hernia contents in some cases. Here we report a case of incarcerated Larrey hernia with small bowel obstruction, which was successfully treated with emergent laparoscopic surgery. CASE PRESENTATION An 87-year-old woman presented to our hospital with abdominal pain and nausea. Computed tomography scan revealed an MLH comprising an obstructed intestinal loop. The patient underwent emergency laparoscopic surgery. Surgical findings showed incarceration of the small bowel on the left side of the falciform ligament. The small bowel was laparoscopically reduced and does not show signs of intestinal ischemia or perforation. The hernia orifice, which was approximately 15 mm in diameter, was closed with a surgical suture without the need for sac excision. The patient was discharged on postoperative day 7 without postoperative complications. CLINICAL DISCUSSION There are no established surgical techniques for the treatment of MLH due to its rarity. Our experience in the present case suggests that the laparoscopic approach might be considered as a feasible method even for incarcerated MLH. CONCLUSION Surgical techniques for MLH should be selected on a case-by-case basis.
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Affiliation(s)
- Noriyuki Sasaki
- Department of Surgery, Iwate Prefectural Ninohe Hospital, 38-2 Okawarage, Horino, Ninohe, Iwate 028-6193, Japan.
| | - Shingo Mitomo
- Department of Surgery, Iwate Prefectural Ninohe Hospital, 38-2 Okawarage, Horino, Ninohe, Iwate 028-6193, Japan
| | - Yusuke Matsui
- Department of Surgery, Iwate Prefectural Ninohe Hospital, 38-2 Okawarage, Horino, Ninohe, Iwate 028-6193, Japan
| | - Yugo Ishii
- Department of Surgery, Iwate Prefectural Ninohe Hospital, 38-2 Okawarage, Horino, Ninohe, Iwate 028-6193, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan
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Laparoscopic and single incision laparoscopic repair of Morgagni hernia in adults. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:513-519. [PMID: 35096449 PMCID: PMC8762901 DOI: 10.5606/tgkdc.dergisi.2021.20983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/13/2020] [Indexed: 11/21/2022]
Abstract
Background: In this study, we aimed to compare multiple versus single incision laparoscopic repair of Morgagni hernia in adults and to investigate effectiveness and feasibility of both techniques.
Methods: Between January 2011 and March 2018, a total of 15 patients (5 males, 10 females; median age: 58.6 years; range, 36 to 70 years) who underwent laparoscopic or single-incision laparoscopic repair of Morgagni hernia were retrospectively analyzed. Demographic and clinical characteristics of patients, perioperative data, and treatment outcomes were evaluated.
Results: The median follow-up was 38 (range, 11 to 84) months. Of the patients with Morgagni hernia, 12 were treated with laparoscopic and three were treated with single incision laparoscopic repair technique. Patient satisfaction was excellent for most of the patients in both groups. No recurrence was observed during follow-up.
Conclusion: Morgagni hernia is a very rare type of hernia in adults. Laparoscopic mesh-reinforced primary repair of Morgagni hernia should be one of the first choice in patients, particularly with large hernias that would cause tension on edges of the diaphragm when closed. Single incision laparoscopic repair of Morgagni hernia is also another laparoscopic option with high patient satisfaction.
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Metchihoungbe CS, Sogbo DHO, Koco H, Yassegoungbe MG, Covi AP, Amoussou AM, Segbedji GGPS, Safari DK, Gogan MVLSB, Assouto CBU, Biaou O, Fiogbe MA. Congenital retro-costo-xiphoid diaphragmatic hernia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Gergen AK, Frankel JH, Weyant MJ, Pratap A. A novel technique of robotic preperitoneal approach for Morgagni hernia repair. Asian J Endosc Surg 2021; 14:648-652. [PMID: 33200531 DOI: 10.1111/ases.12897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/24/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Morgagni hernia (MH) is a rare, congenital diaphragmatic hernia. We developed a novel robotic-assisted technique to repair MH which enables dissection into the preperitoneal space, facilitating closure of the diaphragmatic defect and placement of a synthetic mesh. MATERIALS AND SURGICAL TECHNIQUE Between August 2017 and August 2020, 8 consecutive patients with MH were repaired by robotic-assisted transabdominal preperitoneal (r-TAPP) approach. A preperitoneal plane is developed at the level of the falciform ligament and extended toward the diaphragmatic defect. The pocket is dissected inferior to the defect to allow 3 to 5 cm overlap of synthetic mesh. Excision of the hernia sac followed by closure of defect is performed. A synthetic mesh is deployed in the preperitoneal space with wide overlap. This technique using the robot provides superior optics and ergonomics for dissection while isolating the mesh from underlying viscera and avoiding the need for suturing or tacking of the mesh. Data of patients who underwent r-TAPP were reviewed. Mean operating time was 113 minutes. Mean pain visual analog scale score was 5/2 on post-operative days 1/7. Average hospital stay was 1.8 days. One patient developed superficial cellulitis related to the abdominal drain. There were no procedure-related complications, 30-day readmissions, or hernia recurrences at a mean follow-up of 10 months. DISCUSSION A robotic-assisted preperitoneal approach is a novel, safe, and anatomically justified alternative technique for MH repair that may lead to improved post-operative outcomes.
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Affiliation(s)
- Anna K Gergen
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado, Aurora, Colorado, USA
| | - John H Frankel
- Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado, Aurora, Colorado, USA
| | - Michael J Weyant
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado, Aurora, Colorado, USA
| | - Akshay Pratap
- Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado, Aurora, Colorado, USA
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Leeflang E, Madden J, Ibele A, Glasgow R, Morrow E. Laparoscopic management of symptomatic congenital diaphragmatic hernia of Morgagni in the adult. Surg Endosc 2021; 36:216-221. [PMID: 33438077 DOI: 10.1007/s00464-020-08259-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/18/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Currently, there is a relative paucity of literature regarding the management of symptomatic congenital diaphragmatic hernia of the foramen of Morgagni in the adult. This study aims to describe our unique surgical technique and outcomes in adult patients undergoing laparoscopic repair of symptomatic Morgagni hernia. METHODS This is a retrospective review of adult patients from 2003 to 2020 who underwent a laparoscopic Morgagni hernia repair at our institution. All patients underwent a similar laparoscopic approach, utilizing the surgical principles of reduction of intra-abdominal contents, complete resection of the hernia sac, followed by primary repair of the hernia defect and mesh reinforcement with permanent mesh if the primary repair was subjectively under tension. RESULTS The study population consisted of 12 consecutive patients with a Morgagni hernia. Patients presented with a variety of symptoms attributed to the hernia, including pain 83% (n = 10), respiratory symptoms and shortness of breath 58% (7), and gastrointestinal obstruction 25% (3). Other complaints included: nausea 33% (4), reflux 50% (6), early satiety 8% (1), palpitations 16% (2), a gurgling sensation in the chest 8% (1), and weight loss 8% (1). Primary repair was possible in all patients following complete reduction of hernia contents including the hernia sac. Mesh reinforcement was used in 5 of 12 patients. Average surgical operative time was 93 (± 37) min. Median length of stay was 1.3 days (range 0.5-5.5 days). At a median follow-up of 10.9 months (IQR 8.0-41.5 months), all symptoms attributed to the hernia had resolved. No recurrences were identified. CONCLUSIONS Adults with symptomatic Morgagni hernia should undergo surgical repair. A laparoscopic approach utilizing the surgical principles of reduction of intra-abdominal contents, complete resection of the hernia sac, followed by primary repair of the hernia defect (when possible), with or without mesh reinforcement can be performed safely and effectively.
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Affiliation(s)
- Elisabeth Leeflang
- Department of Surgery, University of Utah, 30 North, 1900 East, Salt Lake City, UT, USA
| | - Jesse Madden
- Department of Surgery, University of Utah, 30 North, 1900 East, Salt Lake City, UT, USA
| | - Anna Ibele
- Department of Surgery, University of Utah, 30 North, 1900 East, Salt Lake City, UT, USA
| | - Robert Glasgow
- Department of Surgery, University of Utah, 30 North, 1900 East, Salt Lake City, UT, USA
| | - Ellen Morrow
- Department of Surgery, University of Utah, 30 North, 1900 East, Salt Lake City, UT, USA.
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Ortenzi M, Balla A, Paganini AM, Biondini G, Lezoche G, Ghiselli R, Guerrieri M. Laparoscopic repair of giant Morgagni hernia by direct suturing with V-Loc. MINERVA CHIR 2020; 75:298-304. [PMID: 33210525 DOI: 10.23736/s0026-4733.20.08477-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Morgagni hernias present technical challenges. The laparoscopic approach for repair was first described in 1992; however, as these hernias are uncommon in adult life, few data exist on the optimal method for surgical management. The purpose of this study was to analyze a method for laparoscopic repair of Morgagni giant hernias using laparoscopic primary closure with V lock (Medtronic, Covidien). METHODS This case series describes a method of laparoscopic Morgagni hernia repair using primary closure. In all patients, a laparoscopic transabdominal approach was used. The content of the hernia was reduced into the abdomen, and the diaphragmatic defect was closed with a running laparoscopic suture using a self-fixating suture. Clips were placed at the edges of the suture to secure the pledged sutures to both the anterior and posterior fascia. Demographic data such as BMI and operative and postoperative data were collected. RESULTS Retrospectively collected data for 9 patients were analyzed. There were 1 (11.1%) males and 8 (88.8%) females. The median BMI was 29.14±52 kg/m<sup>2</sup>. The median operative time was 80±25 minutes. There were no intraoperative complications or conversions to open surgery. Patients began a fluid diet on the first postoperative day and were discharged after a median hospital stay of 3±1.87 days. In a median follow-up of 36 months, we did not observe any recurrences. CONCLUSIONS Transabdominal laparoscopic approach with primary closure of the diaphragmatic defect is a viable approach for the repair of Morgagni hernia. In our experience, the use of laparoscopic transabdominal suture fixed to the fascia allowed the closure of the defect laparoscopically with minimal tension on the repairs.
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Affiliation(s)
- Monica Ortenzi
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy -
| | - Andrea Balla
- Department of General Surgery and Surgical Specialties, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Alessandro M Paganini
- Department of General Surgery and Surgical Specialties, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Giovanni Biondini
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Lezoche
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Roberto Ghiselli
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Mario Guerrieri
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
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Left diaphragmatic hernia following thoracoabdominal aortic repair: A case report. Int J Surg Case Rep 2020; 70:209-212. [PMID: 32417740 PMCID: PMC7229409 DOI: 10.1016/j.ijscr.2020.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/11/2020] [Accepted: 04/24/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Diaphragmatic hernias are somewhat rare complications of thoracoabdominal interventions. Given their late clinical manifestations and misdiagnosis, their incidence is unknown. These hernias have a high mortality risk when an emergency intervention is warranted due to complications from visceral strangulation. CASE PRESENTATION We present the case of a 67-year-old male with prior history of thoracoabdominal aortic repair, who reconsults due to upper gastrointestinal bleeding. Upon arrival, imaging shows a left diaphragmatic herniation with migration of the stomach, omentum and spleen to the thoracic cavity. Through laparoscopic approach, a left diaphragmatic hernial defect is identified with protrusion of half the stomach, omentum and the posterior aspect of the spleen with a sub capsular tear. Additionally, a severe adhesion syndrome on the chest wall and diaphragm were also evident, with entrapment of the inferior lobe of the left lung. The contents were successfully reduced, however pulmonary decortication and extensive adhesiolysis through thoracoscopy was required for complete extraction, enabling a primary repair without tension. CONCLUSIONS We present an infrequent pathology without an established incidence, which has relevant clinical and surgical implications at any level of care, in this case requiring interdisciplinary management. The suspicion of diaphragmatic hernia in a patient with past medical history of thoracoabdominal aortic repair with non-specific gastrointestinal symptoms is essential. We emphasize the importance of clinical suspicion of this complication once the surgical precedent has been identified.
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Oppelt PU, Askevold I, Bender F, Liese J, Padberg W, Hecker A, Reichert M. Morgagni-Larrey diaphragmatic hernia repair in adult patients: a retrospective single-center experience. Hernia 2020; 25:479-489. [PMID: 32112200 PMCID: PMC8055631 DOI: 10.1007/s10029-020-02147-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 02/06/2020] [Indexed: 01/13/2023]
Abstract
Purpose Morgagni−Larrey congenital diaphragmatic hernia (MLH) is rare in adult patients and surgery is performed infrequently. The evidence regarding the most beneficial treatment modality is low. Nevertheless, with increasing experience in minimally-invasive surgery, the literature proves the laparoscopic approach as being safely feasible. However, knowledge on the disease as well as treatment options are based on single surgeon’s experiences and small case series in the literature. Methods Retrospective single-center analysis on adult patients (≥ 18 years) with MLH from 01/2003 to 06/2019 regarding symptoms, hernia sac contents, surgical technique and perioperative outcome. Results 4.0% of diaphragmatic hernia repair procedures were performed for MLH (n = 11 patients). 27.3% of these patients were asymptomatic. Dyspnea or gastrointestinal symptoms were frequently observed (both in 45.5% of the patients). Colon transversum (63.6%), omentum majus (45.5%) and/or stomach (27.3%) were the most common hernia sac contents. Correct diagnosis was achieved preoperatively in 10/11 patients by cross-sectional imaging. All procedures were performed by trans-abdominal surgery (laparotomy in four and laparoscopy in seven patients). All hernias were reinforced by mesh after primary closure. No differences were observed in the perioperative outcome between patients who underwent hernia repair by laparotomy versus laparoscopy. Pleural complications requiring drainage were the most common postoperative complications. Conclusion MLH repair seems to be safely feasible by laparoscopic surgery. The benefit of mesh augmentation in MLH repair is not clear yet. In contrast to the current literature, all patients in this study received mesh augmentation after primary closure of the hernia. This should be evaluated in larger patient cohorts with long-term follow-up.
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Affiliation(s)
- P U Oppelt
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - I Askevold
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - F Bender
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - J Liese
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - W Padberg
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - A Hecker
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - M Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany.
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When and why was the phrenicoabdominal branch of the left phrenic nerve placed into the esophageal hiatus in German textbooks of anatomy? An anatomical study on 400 specimens reevaluating its course through the diaphragm. Ann Anat 2020; 227:151415. [DOI: 10.1016/j.aanat.2019.151415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/04/2019] [Accepted: 08/13/2019] [Indexed: 11/20/2022]
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Çalıkoğlu İ, Özgen G, Toydemir T, Yerdel MA. Iatrogenic cardiac tamponade as a mortal complication of peri-hiatal surgery. Analysis of 30 published cases. Heliyon 2019; 5:e01537. [PMID: 31183416 PMCID: PMC6495070 DOI: 10.1016/j.heliyon.2019.e01537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/12/2019] [Accepted: 04/16/2019] [Indexed: 02/07/2023] Open
Abstract
Iatrogenic cardiac tamponade (ICT) is a dreadful complication of peri-hiatal surgery and vast majority occur during a hernia repair. Strikingly, against all warnings, the incidents and related deaths seem to be increasing. The aim of this review is to provide insight on how to prevent and challenge ICT. PubMed search identified 30 distinct ICTs with 10 deaths (33.3%) due to peri-hiatal procedures. Twenty-nine operations were mechanical repairs and laparoscopic anti-reflux surgery was the primary cause (n:18). Graft fixation (n:23) and helical tacks (n:13) were the main offenders. Initial symptom was hypotension affecting 92%. Seven ICTs were only identified at autopsy. All treated patients except one underwent a drainage. Almost all ICTs were caused by injury to the diaphragmatic dome, anterior to hiatus. In conclusion, peri-hiatal surgery-related ICT is extremely fatal. ICT mainly occurs during the repair of a hernia, a benign condition and therefore must be prevented. Graft fixation, around the ante-hiatal diaphragmatic dome must be abandoned. If mesh-augmentation is absolutely necessary, meticulous stitching must be preferred instead of fixators. Persistent hypotension during or following a peri-hiatal operation is an alarming sign of ICT. Increased awareness is mandatory for prevention and survival.
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Affiliation(s)
- İsmail Çalıkoğlu
- İstanbul Bariatrics and Advanced Laparoscopy Center, Hakkı Yeten Cad., Polat Tower, No: 12, 34343 Fulya-İstanbul, Turkey
| | - Görkem Özgen
- İstanbul Bariatrics and Advanced Laparoscopy Center, Hakkı Yeten Cad., Polat Tower, No: 12, 34343 Fulya-İstanbul, Turkey
| | - Toygar Toydemir
- İstanbul Bariatrics and Advanced Laparoscopy Center, Hakkı Yeten Cad., Polat Tower, No: 12, 34343 Fulya-İstanbul, Turkey
| | - Mehmet Ali Yerdel
- İstanbul Bariatrics and Advanced Laparoscopy Center, Hakkı Yeten Cad., Polat Tower, No: 12, 34343 Fulya-İstanbul, Turkey
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Ryan JM, Rogers AC, Arumugasamy M. Reply to comment to: 'Technical description of laparoscopic Morgagni hernia repair with primary closure and onlay composite mesh placement.'. Hernia 2018; 22:709-710. [PMID: 29754256 DOI: 10.1007/s10029-018-1781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 11/29/2022]
Affiliation(s)
- J M Ryan
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Dublin 9, Ireland.
| | - A C Rogers
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Dublin 9, Ireland
| | - M Arumugasamy
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Dublin 9, Ireland
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Ryan JM, Rogers AC, Hannan EJ, Mastrosimone A, Arumugasamy M. Technical description of laparoscopic Morgagni hernia repair with primary closure and onlay composite mesh placement. Hernia 2018; 22:697-705. [PMID: 29556855 DOI: 10.1007/s10029-018-1760-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 03/10/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Morgagni hernias rarely present in adult life and, thus, little data exist on the optimal method of surgical repair. The laparoscopic approach has grown in popularity since the first reported case in 1992. This article showcases a method for laparoscopic repair of Morgagni hernias using both primary closure and mesh reinforcement. OPERATIVE APPROACH There were three obese women who presented in adulthood with cardiopulmonary symptoms; in all cases, the symptoms were attributable to local compressive effects of large Morgagni hernias. All three hernias were repaired laparoscopically, first by approximating the diaphragm to the fascia of the anterior abdominal wall, followed by insertion of a composite mesh, tacked to the diaphragm, to buttress the closure. All patients had excellent outcomes with symptom resolution. DISCUSSION This case series describes a method of laparoscopic Morgagni hernia repair using primary closure reinforced with a mesh, with excellent postoperative outcomes. Others have described thoracic or open approaches. The authors feel that the method described herein is likely to reduce recurrence in a patient population who are often overweight or obese and, thus, have a high risk of this complication. Furthermore, we discuss all reported laparoscopic repair cases in the literature and highlight the paucity of evidence on the optimal approach.
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Affiliation(s)
- J M Ryan
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Ireland.
| | - A C Rogers
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Ireland
| | - E J Hannan
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Ireland
| | - A Mastrosimone
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Ireland
| | - M Arumugasamy
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Ireland
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Yerdel MA, Şen O, Zor U, Kara S, Acunaş B. Cardiac Tamponade as a Life-Threatening Complication of Laparoscopic Antireflux Surgery: The Real Incidence and 3D Anatomy of a Heart Injury by Helical Tacks. J Laparoendosc Adv Surg Tech A 2018; 28:1041-1046. [PMID: 29493372 PMCID: PMC6157358 DOI: 10.1089/lap.2017.0713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Cardiac tamponade (CT) is a dreadful complication of laparoscopic antireflux surgery (LARS) with unknown incidence, and preventive measures are yet to be defined. Incidence during LARS with respect to usage/configuration of graft deployment is analyzed. Three-dimensional (3D) analysis of tack distribution provided anatomical insight to prevent cardiac injury. Materials and Methods: Data regarding the usage and configuration of graft deployment are retrieved from the prospective database. Grafting was “posterior” or “posterior + anterior.” Incidence of CT in all hiatoplasties is calculated. Tomography is reconstructed in 3D, showing the spatial distribution of the tacks. Tacks are numbered in the surgical video. Corresponding numbering is applied to the tacks in any particular tomography slice, utilizing the 3D images as an interface. A numbering-blinded radiologist is asked to identify the offending and the nonoffending tacks as the cause of tamponade. Tack-to-pericardium distances are recorded. Tacks having no measurable distance from the pericardium are regarded as offensive. Results: One CT occurred in 1302 consecutive LARS (0.076%). The incidence is 0% when “no” (379) or “posterior” (880) graft is used as opposed to 2.3% rate in “posterior + anterior” (43) grafting. The distribution of “offensive,” “nonoffensive but nearest,” and “safe” tacks followed a pattern. All offensive tacks belonged to the anterior graft fixation, which we referred as the critical zone. Conclusion: CT during LARS is rare, and associated with graft fixation anterior to the hiatal opening. Avoiding graft fixation to the critical zone may prevent cardiac injury.
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Affiliation(s)
- Mehmet Ali Yerdel
- 1 İstanbul Bariatrics and Advanced Laparoscopy Center , Istanbul, Turkey
| | - Ozan Şen
- 1 İstanbul Bariatrics and Advanced Laparoscopy Center , Istanbul, Turkey
| | - Utku Zor
- 2 Department of Cardiology, Acıbadem Fulya Hospital , Istanbul, Turkey
| | - Simay Kara
- 3 Department of Radiology, Acıbadem University Medical School , Istanbul, Turkey
| | - Bülent Acunaş
- 4 Department of Radiology, İstanbul University Medical School , Istanbul, Turkey
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A word of caution: never use tacks for mesh fixation to the diaphragm! Surg Endosc 2018; 32:3295-3302. [PMID: 29340811 PMCID: PMC5988756 DOI: 10.1007/s00464-018-6050-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 01/11/2018] [Indexed: 11/10/2022]
Abstract
Background The mesh fixation technique used in repair of hiatal hernias and subxiphoid ventral and incisional hernias must meet strenuous requirements. In the literature, there are reports of life-threatening complications with cardiac tamponade and a high mortality rate on using tacks. The continuing practice of tack deployment for mesh fixation to the diaphragm and esophageal hiatus should be critically reviewed. Methods In a systematic search of the available literature in May 2017, 23 cases of severe penetrating cardiac complications were identified. The authors became aware of two other cases in which they acted as medical experts. Furthermore, the instructions for use issued by the manufacturers of the tacks were reviewed with regard to their deployment in the diaphragm. Results Twenty-three of 25 cases (92%) with severe cardiac injuries and subsequent cardiac tamponade were triggered by the use of tacks in the diaphragm. In six cases (24%), these related to ventral and incisional hernias with extension to the subxiphoid area, and in 19 cases (76%) to mesh-augmented hiatoplasty. Twelve of 25 (48%) patients died as a result of pericardial and/or heart muscle injury with cardiac tamponade despite heart surgery intervention. In the tack manufacturers’ instructions for use, their deployment in the diaphragm, in particular in the vicinity of the heart, is contraindicated. Likewise, the existing guidelines urgently advise against the use of tacks in the diaphragm, recommending instead alternative fixation techniques. Conclusions Tacks should not be used for mesh fixation in the diaphragm above the costal arch.
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Arikan S, Dogan MB, Kocakusak A, Ersoz F, Sari S, Duzkoylu Y, Nayci AE, Ozoran E, Tozan E, Dubus T. Morgagni's Hernia: Analysis of 21 Patients with Our Clinical Experience in Diagnosis and Treatment. Indian J Surg 2017; 80:239-244. [PMID: 29973754 DOI: 10.1007/s12262-016-1580-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 12/23/2016] [Indexed: 01/30/2023] Open
Abstract
A Morgagni's hernia is a congenital defect found in the anterior aspect of the diaphragm between the costal and the sternal portions of this muscle. This defect is also referred to as the space of Larrey. It has been reported that 70% of patients with Morgagni's hernia are female, 90% of the hernias are right-sided, and 92% of the hernias have hernia sacs. This type of hernia is a rare clinical entity and accounts for 3% of all surgically treated diaphragmatic hernias. There are no large retrospective or prospective studies on this topic. This type of hernia is a rare type among adults without a well-described prevalence and without well-established definitive management strategies. There are also few clinical reports about this clinical entity and its surgical treatment. We treated 21 patients with Morgagni's hernia in a 12-year period, and we report our experience while discussing the surgical treatment of this disease. We performed a retrospective review of the 21 patients who were operated between 2003 and 2015. These patients had undergone surgical repair of Morgagni's hernia. For each subject, demographic data, symptoms of presentation, physical examination findings, preoperative imaging studies and diagnosis, and surgical procedures were documented. Location of the hernia sac and its contents, postoperative complications, and duration of hospital stay were recorded and evaluated. Twelve patients were females and nine were males. The mean age of patients was 63.85 years. Dyspnea was the most prominent symptom in our patients. Morgagni's hernias were located on the right side in 19 patients and on the left side in 2 patients. Chest X-ray in 10 patients and abdominal computerized tomography in 17 patients were the major diagnostic tools. Four patients were operated as emergency while others underwent elective surgery (17 patients). Twelve patients were operated with laparoscopy and the remaining nine were operated with the conventional open abdominal technique. Hernia sacs were observed in all of the patients and removed except in four of them. The omentum and the transverse colon were the most commonly seen organs in hernia sacs. Hernia defects were repaired with primary sutures in four patients (all open cases) and primary closure supported with mesh in six patients (four laparoscopic, two open cases). In the remaining 11 patients, hernia defects were closed with synthetic meshes (eight laparoscopic, three open cases). Mean postoperative hospital stay was 9.8 days. No recurrence was observed in any patients. Only one of our patients died during follow-up. In Morgagni's hernias, surgical intervention is necessary as the hernia may cause complications such as strangulation of the colon or intestines. A laparoscopic approach has increased its popularity in recent years because of the well-known advantages of laparoscopy.
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Affiliation(s)
- Soykan Arikan
- 1General Surgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Baki Dogan
- 1General Surgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Kocakusak
- 2General Surgery Clinic, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Feyzullah Ersoz
- 1General Surgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Serkan Sari
- 1General Surgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Yigit Duzkoylu
- 1General Surgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ali Emre Nayci
- 1General Surgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Emre Ozoran
- 1General Surgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Emine Tozan
- 3Anesthesiology and Reanimation Clinic, Istanbul University School of Medicine, Istanbul, Turkey
| | - Turkan Dubus
- 4Thoracic Surgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
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Shah M, Walia A. Congenital peritoneo-pericardial hernia in an adult. APOLLO MEDICINE 2016. [DOI: 10.1016/j.apme.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Single-Incision Laparoscopic Nontraumatic Left Lateral Diaphragmatic Hernia Repair. Surg Laparosc Endosc Percutan Tech 2016; 25:e166-9. [PMID: 26429061 DOI: 10.1097/sle.0000000000000194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Diaphragmatic hernia is a quite uncommon disease, being congenital or posttraumatic. Its diagnosis is frequently accidental. Surgical treatment can be performed through the abdomen as well as through the chest. Laparoscopy and thoracoscopy offer a surgical benefit because of reduced wall trauma and added advantages of minimally invasive surgery. Besides the improved cosmetic result, transumbilical single-incision laparoscopy can add other advantages to minimally invasive surgery like reduced postoperative pain, shorter hospital stay, and improved patient's comfort. The authors describe the technique of transumbilical single-incision laparoscopic suture and mesh reinforcement for a nontraumatic left lateral diaphragmatic hernia, discovered accidentally in a 45-year-old male.
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Pathak D, Tantia O, Chaudhuri T, Singh JP. A Rare Variant of Diaphragmatic Hernia through the Central Tendon: A Case Report. Indian J Surg 2013; 76:234-6. [PMID: 25177124 DOI: 10.1007/s12262-013-0959-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 07/26/2013] [Indexed: 11/29/2022] Open
Abstract
Diaphragmatic hernia through the central tendon is a very rare entity. We report on a case that developed to acute intestinal obstruction, secondary to herniation of the small intestine through a small defect in the central tendon of the diaphragm. The patient never had any trauma to his chest or abdomen and had no history suggestive of congenital nature of the diaphragmatic hernia. However, he had coronary artery bypass grafting with saphenous vein used as a graft, done almost 17 years back; hence, we suspect it to be an iatrogenic hernia. A laparoscopic herniorrhaphy of the diaphragmatic defect was carried out after reducing the herniated organ. The postoperative course was uneventful. Iatrogenic diaphragmatic hernias are a very rare entity. We are reporting on a central tendon hernial defect in the diaphragm after coronary artery bypass with saphenous vein as a graft material. There are reported cases with post coronary artery bypass graft diaphragmatic hernia in which the right gastroepiploic artery was taken as the graft material. Late diagnosis of iatrogenic diaphragmatic hernias is frequent. CT scan is helpful for diagnosis. Surgery is the treatment of diaphragmatic hernia at the time of diagnosis, even with asymptomatic patients.
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Affiliation(s)
- Digant Pathak
- Department of Minimal Access and Bariatric Surgery, ILS Hospitals, DD-6, Salt Lake City, Sector 1, Kolkata, 700064 India
| | - Om Tantia
- Department of Minimal Access and Bariatric Surgery, ILS Hospitals, DD-6, Salt Lake City, Sector 1, Kolkata, 700064 India
| | - Tamonas Chaudhuri
- Department of Minimal Access and Bariatric Surgery, ILS Hospitals, DD-6, Salt Lake City, Sector 1, Kolkata, 700064 India
| | - Jagat Pal Singh
- Department of Minimal Access and Bariatric Surgery, ILS Hospitals, DD-6, Salt Lake City, Sector 1, Kolkata, 700064 India
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Soufi M, Meillat H, Le Treut YP. Right diaphragmatic iatrogenic hernia after laparoscopic fenestration of a liver cyst: report of a case and review of the literature. World J Emerg Surg 2013; 8:2. [PMID: 23286877 PMCID: PMC3544607 DOI: 10.1186/1749-7922-8-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 12/20/2012] [Indexed: 11/15/2022] Open
Abstract
Iatrogenic right diaphragmatic hernia is very rare. We report the first case of a patient who had a diaphragmatic hernia after laparoscopic fenestration of liver cyst. A herniorrhaphy of the diaphragmatic defect was carried out after reducing the herniated organ. The postoperative course was uneventful. Diaphragmatic hernias are not as common as the traumatic type. Surgeons can easily miss diaphragmatic injuries during the operation especially after laparoscopy. Late diagnosis of iatrogenic diaphragmatic hernias is frequent. Ct scan is helpful for diagnosis. Surgery is the treatment of diaphragmatic hernia at the time of diagnosis, even with asymptomatic patients. The incidence of iatrogenic diaphragmatic hernia after surgery may be reduced if the surgeon checks for the integrity of the diaphragm before the end of the operation. A review of the literature is also performed regarding this rare complication.
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Affiliation(s)
- Mehdi Soufi
- Division of digestive Surgery and transplantation, Hopital de la Conception, Marseille, France.
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Ayiomamitis GD, Stathakis PC, Kouroumpas E, Avraamidou A, Georgiades P. Laparoscopic repair of congenital diaphragmatic hernia complicated with sliding hiatal hernia with reflux in adult. Int J Surg Case Rep 2012; 3:597-600. [PMID: 22986157 DOI: 10.1016/j.ijscr.2012.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 08/15/2012] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Congenital diaphragmatic hernia (CDH) in adults is a relatively rare condition being asymptomatic in the majority of cases. Symptomatic CDH should prompt surgical management because they may lead to intestinal obstruction or severe pulmonary disease. This is the first reported case of a symptomatic CDH complicated with sliding hiatal hernia (SHH). PRESENTATION OF CASE A 65 years old women with reflux and dysphagia was complaining of postprandial paroxysmal dyspnea and epigastric pain radiating to her back. Upper endoscopy diagnosed sliding and para-esophageal diaphragmatic hernia with severe esophagitis. Computed tomography-scan revealed a large Bochdalek hernia at the left diaphragm. DISCUSSION Diagnostic laparoscopy was decided, which confirmed the SHH, but also revealed a CDH defect at the tendonous part of the left diaphragm. The left bundle of the right crus was intact, separating the two hernia components (sliding and congenital). Extensive adhesiolysis was performed, dissecting and separating the stomach away from the diaphragm. Posterior cruroplasty at the esophageal hiatus was performed for the SHH with Nissen fundoplication as antireflux procedure. Primary continuous suture repair was performed for the CDH, reinforced with prosthetic mesh on top. Operative time was 150min with no morbidity. The patient was discharged home uneventfully the third postoperative day. On 12-months follow-up, she reported no symptoms and improvement in quality of life. CONCLUSION Laparoscopy is a unique method for a precise diagnosis of symptomatic congenital diaphragmatic hernia in adults being also a safe and viable technique for a successful repair at the same time. Experience of advanced laparoscopic surgery is required.
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Affiliation(s)
- Georgios D Ayiomamitis
- 2nd Surgical Department, Tzaneion General Hospital of Piraeus, Greece; Chicago Institute of Minimally Invasive Surgery, Skokie, IL, USA.
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Agresta F, Ansaloni L, Baiocchi GL, Bergamini C, Campanile FC, Carlucci M, Cocorullo G, Corradi A, Franzato B, Lupo M, Mandalà V, Mirabella A, Pernazza G, Piccoli M, Staudacher C, Vettoretto N, Zago M, Lettieri E, Levati A, Pietrini D, Scaglione M, De Masi S, De Placido G, Francucci M, Rasi M, Fingerhut A, Uranüs S, Garattini S. Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d'Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell'Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc 2012; 26:2134-64. [PMID: 22736283 DOI: 10.1007/s00464-012-2331-3] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 04/16/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND In January 2010, the SICE (Italian Society of Endoscopic Surgery), under the auspices of the EAES, decided to revisit the clinical recommendations for the role of laparoscopy in abdominal emergencies in adults, with the primary intent being to update the 2006 EAES indications and supplement the existing guidelines on specific diseases. METHODS Other Italian surgical societies were invited into the Consensus to form a panel of 12 expert surgeons. In order to get a multidisciplinary panel, other stakeholders involved in abdominal emergencies were invited along with a patient's association. In November 2010, the panel met in Rome to discuss each chapter according to the Delphi method, producing key statements with a grade of recommendations followed by commentary to explain the rationale and the level of evidence behind the statements. Thereafter, the statements were presented to the Annual Congress of the EAES in June 2011. RESULTS A thorough literature review was necessary to assess whether the recommendations issued in 2006 are still current. In many cases new studies allowed us to better clarify some issues (such as for diverticulitis, small bowel obstruction, pancreatitis, hernias, trauma), to confirm the key role of laparoscopy (such as for cholecystitis, gynecological disorders, nonspecific abdominal pain, appendicitis), but occasionally previous strong recommendations have to be challenged after review of recent research (such as for perforated peptic ulcer). CONCLUSIONS Every surgeon has to develop his or her own approach, taking into account the clinical situation, her/his proficiency (and the experience of the team) with the various techniques, and the specific organizational setting in which she/he is working. This guideline has been developed bearing in mind that every surgeon could use the data reported to support her/his judgment.
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Affiliation(s)
- Ferdinando Agresta
- Department of General Surgery, Presidio Ospedaliero di Adria, Piazza degli Etruschi, 9, 45011 Adria, RO, Italy.
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von Rahden BHA, Spor L, Germer CT, Dietz UA. Three-component intraperitoneal mesh fixation for laparoscopic repair of anterior parasternal costodiaphragmatic hernias. J Am Coll Surg 2011; 214:e1-6. [PMID: 22056356 DOI: 10.1016/j.jamcollsurg.2011.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 09/22/2011] [Accepted: 10/03/2011] [Indexed: 10/15/2022]
Affiliation(s)
- Burkhard H A von Rahden
- Department of General, Visceral, Vascular and Pediatric Surgery, University of Wuerzburg, Wuerzburg, Germany
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Marhuenda C, Guillén G, Sánchez B, Urbistondo A, Barceló C. Endoscopic repair of late-presenting Morgagni and Bochdalek hernia in children: case report and review of the literature. J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:S95-101. [PMID: 19281423 DOI: 10.1089/lap.2008.0175.supp] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Delayed presentation of a congenital diaphragmatic hernia (CDH) is not usual. Primary laparoscopic repair is becoming the standard in many centers. Different approaches and techniques have been proposed. There is not enough evidence in the literature to recommend one technique over another. PATIENTS AND METHODS In this paper, we report one case of Morgagni hernia (MH) and one case of Bochdalek hernia (BH), 2 and 6 years old, respectively, operated on in our hospital. In the first case, the diaphragmatic defect was directly sutured with extracorporeal interrupted nonabsorbable sutures, passed through the abdominal wall with a Reverdin needle. In the second one, intracorporeal nonabsorbable stitches were placed. A search of the literature was made using PubMed and the following words: congenital diaphragmatic hernia, laparoscopy or thoracoscopy, and children. The neonatal Bochdalek hernias were discarded. Data about surgical approach, suturing technique, management of the hernia sac, complications, and recurrence were summarized for both pathologies. RESULTS Both patients were discharged 48 hours after surgery. There were no complications. No recurrence was evident after 6 months. Eleven articles on the treatment of MHs were found, with a total of 30 patients. For BHs, 10 articles met the inclusion criteria, with a total of 54 patients. In both groups, all the papers were case reports or retrospective reviews of case series. The MH is best approached through laparoscopy, and the BH can be treated through thoracoscopy or laparoscopy. Most researchers prefer direct suture with nonabsorbable material. Both complication and recurrence rates are very low. CONCLUSIONS The endoscopic approach of late-presenting Morgagni and Bochdalek CDH is a safe technique. It offers all the advantages of minimally invasive surgery (MIS), and laparoscopy also permits the diagnosis and treatment of other associated conditions. There are a short number of cases reported and no prospective study comparing open with the MIS approach for the treatment of diaphragmatic malformations.
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Affiliation(s)
- Claudia Marhuenda
- Department of Pediatric Surgery, Vall d'Hebron Pediatric Hospital, Barcelona, Spain.
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24
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Laparoscopic repair of iatrogenic diaphragmatic hernias after sternectomy and pedicled omentoplasty. Hernia 2009; 13:617-23. [PMID: 19710999 DOI: 10.1007/s10029-009-0551-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 08/07/2009] [Indexed: 10/20/2022]
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Abstract
PURPOSE OF REVIEW To evaluate the impact of recent research on the management of congenital diaphragmatic hernia in the light of new theories on embryological development, earlier antenatal diagnosis, fetal and postnatal interventions together with advances in perinatal intensive care. RECENT FINDINGS The year 2007 provided in excess of 200 publications that address various aspects of congenital diaphragmatic hernia. The genetic basis and the causes of pulmonary hypoplasia at the molecular level are slowly being unravelled. Fetal MRI of lung volume, lung-head ratio, liver position and size of diaphragmatic defect have all been evaluated as early predictors of outcome and with a view to prenatal counselling. The impact of fetal interventions such as fetal endoluminal tracheal occlusion, the mode of delivery, the surgical techniques and agents for treating pulmonary hypertension were evaluated. The influence of associated anomalies and therapeutic interventions on the outcome and quality of life of survivors continue to be appraised. SUMMARY Deferred surgery after stabilization with gentle ventilation and reversal of pulmonary hypertension remain the cornerstones of management. Optimal presurgery and postsurgery ventilatory settings remain unproven. Continued improvement in neonatal intensive care raises the bar against which any intervention such as fetal endoluminal tracheal occlusion and extracorporeal membrane oxygenation will be judged.
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Park YS, Lee YK, Baek SH, Jeong SM, Hwang JH. Unexpected cardiac tamponade during robot-assisted permanent pacemaker insertion -A case report-. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.55.4.498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Young-soo Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Yoon Kyung Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Seung Hye Baek
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sung-moon Jeong
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jai Hyun Hwang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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Esmer D, Alvarez-Tostado J, Alfaro A, Carmona R, Salas M. Thoracoscopic and laparoscopic repair of complicated Bochdalek hernia in adult. Hernia 2007; 12:307-9. [PMID: 17990045 DOI: 10.1007/s10029-007-0293-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 10/12/2007] [Indexed: 10/22/2022]
Abstract
Bochdalek's hernia is a congenital defect of the diaphragm that occurs predominantly in children. Perforation or necrosis of the involved organ is a feared complication and surgical repair constitutes the gold standard of treatment. We present a case of a 42-year-old female patient who presented with a 3-month history of left-upper-quadrant abdominal pain, nausea, tachycardia, and early postprandial vomit. Physical exploration was remarkable for audible peristalsis in the left hemithorax. Total white blood count was elevated and chest X-rays showed images of intestines in the left hemithorax. Tomography with double contrast reported left colon herniated to thorax. Left thoracoscopy was practised, finding a Bochdalek's hernia with presence of herniated descendent colon with a necrotic area, which was perforated and sealed. The herniated content was returned back in place, the diaphragmatic defect was corrected, and colostomy by laparoscopy was simultaneously performed. Her postoperative recovery was uneventful and she was discharged from the hospital. Combined thoracoscopy and laparoscopic surgery is effective in complicated cases of Bochdalek's hernia in adults, lessening surgical trauma and postsurgical morbidity.
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Affiliation(s)
- D Esmer
- Hospital Central Ignacio Morones Prieto, San Luís Potosí, SLP, México.
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Kelly MD. Laparoscopic repair of strangulated Morgagni hernia. World J Emerg Surg 2007; 2:27. [PMID: 17935621 PMCID: PMC2098753 DOI: 10.1186/1749-7922-2-27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Accepted: 10/12/2007] [Indexed: 11/10/2022] Open
Abstract
A 73 year old man presented with vomiting and pain due to a strangulated Morgagni hernia containing a gastric volvulus. Laparoscopic operation allowed reduction of the contents, excision of necrotic omentum and the sac, with mesh closure of the large defect. A brief review of the condition is presented along with discussion of the technique used.
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Affiliation(s)
- Michael D Kelly
- Department of Upper GI Surgery, Frenchay Hospital, Bristol, BS16 1LE, UK.
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